Acute Cardiac Arrhythmias Following Surgery for Congenital Heart Disease: Mechanisms, Diagnostic Tools, and Management
Section snippets
Mechanisms of cardiac arrhythmias
In the immediate postoperative period, acute arrhythmia management can be challenging. To optimize patient outcomes, it is beneficial to identify the mechanism and severity of the arrhythmia with respect to overall hemodynamics and to intervene with a brisk treatment plan. The goal of these interventions is to re-establish a normal cardiac rhythm as rapidly as possible in order to avoid unwanted sequelae. Because the mechanism of the arrhythmia can be pivotal in determining the best
Arrhythmia overview
Supraventricular tachycardia (SVT) is a broad category of arrhythmias that includes atrial tachycardia, AF, and JET. Owing to the fact that these arrhythmias can originate anywhere above the bifurcation of the bundle of His, they generally exhibit the same QRS complex on the surface ECG as that of sinus rhythm. The P waves are often not visible or are hard to discern due to the rapid ventricular rate. Additional testing may be required to differentiate the type of SVT. The most common form of
Tools for diagnostic evaluation
Although it is not always possible to differentiate arrhythmias based on their mechanisms, it is helpful to distinguish arrhythmias based on common characteristics and behaviors.20 In critical situations, a clinician must be able to discern the type of arrhythmia quickly and intervene in order to prevent further deterioration of the rhythm and preserve hemodynamic stability of the patient. There are several tools available to assist in the diagnosis of early postoperative arrhythmias.
Management of postoperative arrhythmias
The urgency in the management of arrhythmias in the postoperative period is based on a patient’s hemodynamic status and, in part, by the mechanism of the arrhythmia. If the mechanism of the arrhythmia is unclear, a clinician may use the diagnostic tools (discussed previously) to identify the rhythm abnormality. Multiple modalities may be used in the treatment of these arrhythmias. The hemodynamic status of patients largely determines in what order these modalities are implemented. The treatment
Nursing considerations
Nursing care of pediatric postoperative surgical patients can be challenging. Nurses must be aware of physiologic processes, changing hemodynamic status, impact of medications and interventions on the arrhythmia, and the psychodynamics of patients and families. Nurses should recognize a postoperative rhythm and intervene swiftly if hemodynamic status is compromised. If feasible, patients and families should be informed about the rhythms, their impact on patients, and interventions required to
References (37)
- et al.
Early postoperative arrhythmias after cardiac operation in children
Ann Thorac Surg
(2002) - et al.
Early postoperative arrhythmias after pediatric cardiac surgery
J Thorac Cardiovasc Surg
(2006) Risk factors for cardiac arrhythmias in children with congenital heart disease after surgical intervention in the early postoperative period
J Thorac Cardiovasc Surg
(2007)- et al.
Procedural factor associated with early postoperative arrhythmias after repair of congenital heart defects
J Thorac Cardiovasc Surg
(2002) - et al.
Junctional ectopic tachycardia in children: electrocardiography, electrophysiology and pharmacologic response
Am J Cardiol
(1979) - et al.
Postoperative junctional ectopic tachycardia in children: incidence, risk factors, and treatment
Ann Thorac Surg
(2002) - et al.
Evaluation of a staged treatment protocol for rapid automatic junctional tachycardia after operation for congenital heart disease
J Am Coll Cardiol
(1997) - et al.
Magnesium flux during and after open heart operations in Children
Ann Thorac Surg
(1995) - et al.
Predictors for hemodynamic improvement with temporary pacing after pediatric cardiac surgery
J Thorac Cardiovasc Surg
(2011) - et al.
The utility and safety of temporary pacing wires in postoperative patients with congenital heart disease
J Thorac Cardiovasc Surg
(2007)
Pediatric use of intravenous amiodarone: efficacy and safety in critically ill patients from a multicenter protocol
J Am Coll Cardiol
Postoperative arrhythmia
Curr Opin Cardiol
The incidence of perioperative arrhythmias
Early postoperative arrhythmias after open-heart procedures in children with congenital heart disease
Pediatr Crit Care Med
The incidence of arrhythmias in a pediatric cardiac intensive care unit
Pediatr Cardiol
Magnesium supplementation in the prevention of arrhythmias in pediatric patients undergoing surgery for congenital heart defects
Am Heart J
Development of the cardiac conduction system
Circ Res
Foundations of cardiac arrhythmias: basic concepts and clinical approaches
Cited by (15)
Arrhythmias in the Pediatric Population
2018, Cardiac Electrophysiology: From Cell to Bedside: Seventh EditionThe Fontan procedure for single-ventricle physiology
2018, Critical Care NurseNursing Care in ICU
2018, Congenital Heart Disease: The Nursing Care HandbookCritical care in pediatric cardiac surgery
2017, Cardiac Surgery: Operations on the Heart and Great Vessels in Adults and Children2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
2016, European Journal of Cardio-thoracic Surgery
The authors have nothing to disclose.